Friday

Aug 16, 2019 at 9:12 AM

It’s been seven years since Alexis Conell received the kidney transplant that saved her life, but the 53-year-old Chicago woman isn’t exactly celebrating.

Although the federal government paid most of the costs for her 2012 transplant, a long-standing Medicare policy halted coverage three years later for the drugs that keep her body from rejecting the organ.

So when Conell lost her job suddenly last September, she also lost her health insurance — and her ability to afford the 16 daily medications she needs to survive.

For nearly a half-century, Medicare has covered patients, regardless of age, who have end-stage renal disease, including paying the costs of kidney transplants and related care, which run about $100,000 per patient.

But coverage ends after 36 months for those younger than 65 who don’t otherwise qualify for the program — and that includes payment for the vital immunosuppressive drugs that cost thousands per patient each month.

July’s announcement of a Trump administration overhaul of kidney care in the U.S. has reanimated an effort by federal lawmakers and kidney care advocates to extend drug coverage.

“After a transplant, patients should not have to worry about whether they can afford the treatment needed to keep their transplanted kidney,” Rep. Ron Kind (D-Wis.) said in a statement.

For years, Kind has been among a bipartisan coalition in Congress championing legislation targeting kidney immunosuppressive drugs — to no avail.The sticking point was price. A 2009 estimate by the Congressional Budget Office pegged the cost at $400 million over 10 years if the government were to extend lifetime drug coverage to those patients.

Two recent federal projections show that Medicare could actually save money — between $73.4 million and $120 million over a decade — by expanding payment for anti-rejection medications to help decrease the need for patients to get additional transplants or dialysis. Depending on financing, savings could reach $300 million in that period, suggested an estimate by the Centers for Medicare & Medicaid Services.

New efforts in Congress will hinge on whether the CBO agrees that paying for the medication would save the government money, advocates said. Even the new estimates by CMS suggest that changing the program would increase costs initially, with savings apparent only after a decade.

Dr. Emily Blumberg, president of the American Society of Transplantation, said there appears to be high-level support for change now. In championing the overhaul of U.S. kidney care policy, Health and Human Services Secretary Alex Azar has cited a personal tie, noting that his father suffered from kidney failure and received a transplant in 2014.

Critically, Azar said during the announcement last month that the Trump administration is supportive of the legislative efforts. “We are hoping Congress will work together with us to relieve that time limit so that we can support patients on immunosuppressants over the long term,” he said.

On a call with reporters last month, Tonya Saffer, vice president for health policy at the National Kidney Foundation, said that with the administration’s backing, the group is hopeful that this legislation might finally go somewhere. A key next step is an analysis on what it would cost or save from the Congressional Budget Office.

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.